SCHIZOPHRENIA 1911 - Swiss psychiatrist Eugene Bleuler.

Greek words - schizein (to split) and phren (mind) complex neurobiological brain disease affecting ones ability to perceive and process information and involving a number of syndromes. causes distorted and bizzare thoughts, perceptions, emotions, movements and behavior. cant be defined as a single illness. CLINICAL COURSE Onset Abrupt or insidious, but most clients slowly & gradually develop s/sx such as social withdrawal, unusual behavior, loss of interest in school or work, & neglected hygiene. Dx-made when the person begins to display more active positive symptoms of delusions, hallucinations & disordered thinking. Those who develop the illness earlier show worse outcomes than those who develop it later. Immediate course: The client experiences ongoing psychosis and never fully recovers, although symptoms may shift in severity over time. The client experiences episodes of psychotic symptoms that alternate with episodes of relatively complete recovery from psychosis Long term course Tends to diminish with age. Regain some degree of social and occupational functioning. Over time, the disease becomes less disruptive to the persons life & easier to manage, but rarely can the client overcome the effects of many years of dysfunction. In later life, they may live independently or in a structured family-type setting & may succeed at jobs with stable expectations & a supportive work environment. Most clients have difficulty functioning in the community & a few lead fully independent lives. Etiology Biological Factors a. Genetic b. Neuroanatomic c. Neurochemical d. Immunovirologic 2. Psychological Factors 3. Sociocultural and Environmental Factors Genetic: Identical twin 50% Fraternal twin 15% One parent 15% Both parents 35% Sibling 10% 2 relative 2 to 3% Adopted at birth

Less brain tissue and cerebrospinal fluid. Failure in brain development or a subsequent loss of tissue. Changes within the brain affects language and memory. Neorochemical factor Alterations in the neurotransmitter systems.

Dysregulation hypothesis of schizophrenia: a. Mesolimbic area (limbic system) has overactive dopamine pathways. Function-memory, smell and emotional behavior. b. Mesocortical area (frontal lobes) has hypoactive dopamine pathways. Function-insight, judgment, social consciousness, inhibition, and highest level of cognitive activities such reasoning, motivation, planning and decision making. c. An imbalance exists between dopamine and serotonin neurotransmitter systems. Immonovirologic factor Prenatal exposure to the influenza virus (second trimester) Psychological factor Poor care giving Failure to accomplish an early stage of psychosocial development Inability to cope with stress. Socio cultural factor Poverty Society Cultural disharmony Living in isolation Positive symtoms Exaggeration or distortion of normal function. Responsive to traditional antipsychotic drugs. Mesolimbic system. Looseness of association fragmented or poorly related thoughts and ideas Delusions fixed false beliefs that have no basis in reality Persecutory / Paranoid Delusions involve the clients belief that others are planning to harm the

client or are spying, following, ridiculing, or belittling the client in some way. Grandiose Delusions characterized by the clients claim to association with famous people or celebrities, or the clients belief that he or she is famous or capable of great feats. Religious Delusions often center around the second coming of Christ or another significant religious figure or prophet. These religious delusions appear suddenly as part of the clients psychosis and are not part of his or her religious faith or that of others. Somatic Delusions are generally vague and unrealistic beliefs about the clients health or bodily functions. Factual information or diagnostic testing does not change these beliefs. Referential Delusions / Ideas of Reference involve the clients belief that television broadcasts, music, or newspaper articles have special meaning for him or her. Echopraxia -Imitation of the movements and gestures of another person whom the client is observing. Echolalia-Imitation or repetition of what another person says. Flight of ideas-a constant flow of speech in which the individual jumps from one topic to another in rapid succession, there is a connection between topics, although it is sometimes difficult to identify. Hallucination-false sensory perceptions or perceptual experiences that do not exist in reality. Auditory Hallucinations involve hearing sounds, most often voices, talking to or about the client. Visual Hallucinations involve seeing images that do not exist at all or distortions. Olfactory Hallucinations involve smells or odors. Tactile Hallucinations involve feeling touch sensations in the absence of stimuli Gustatory Hallucinations involve experiencing taste in the absence of stimuli. Cenesthetic Hallucinations involve the clients report that he or she feels bodily functions that are usually undetectable. Kinesthetic Hallucinations occur when the client is motionless but reports the sensation of bodily movement. Perseveration-The persistent adherence to a single idea or topic and verbal repetition of a sentence, phrase, or word, even when another person attempts to change the topic. Word salad-is a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener. Negative Symptoms Diminution or loss of normal function. Usually unresponsive to traditional antipsychotics. More responsive to atypical antipsychotics. Mesocortical system. Alogia-Tendency to speak very little or to convey little substance of meaning (poverty of content) Anhedonia-feeling no joy or pleasure from life or any activities or relationships. Apathy-feelings of indifference toward people, activities, and events. Catatonia-psychologically induced immobility occasionally marked by periods of agitation or excitement; the client seems motionless. Waxy flexibility-having ones arms or legs placed in a certain position and holding that same position for hours. Avolition-absence of will, ambition, or drive to take action or accomplish tasks. Flat affect-absence of any facial expression that would indicate emotions or mood. Blunted affect-restricted range of emotional feeling, tone, or mood. Unusual speech pattern Clang association-are ideas that are related to one another based on sound or rhyming rather than meaning. Neologism-are words invented by the client. Verbigeration-is the stereotyped repetition of words or phrases that may or may not have meaning to the listener. Stilted language-is the use of words or phrases that are flowery, excessive, and pompous. Perseveration-is the persistent adherence to a single idea or topic and a verbal repetition of a sentence phrase, or word, even when another person attempts to change the topic. Judgment is based on the ability to interpret the environment correctly. Lack of judgment is so severe that client cant meet their needs for safety & protection & place themselves in harms way.

 Insight is also impared, especially when family & relatives dont understand what is happening. Lack of a clear sense of where his or her own body, mind, & influence end & where those aspects of other animate & inanimate objects begin . Clients believe they are fused with another person or object, may not recognized body parts as their own, or may fail to know whether they are male or female. Inattention to hygiene & grooming needs is common, especially during psychotic episodes . Preoccupied with delusions or hallucinations leading to nonperforming of basic daily living activities. Failure to recognized sensations such as hunger or thirst, food or fluid intake may be inadequate. Sleep problems are common. TYPES: Paranoid type Persecutory or grandiose delusions, hallucinations, and occasionally, excessive religiosity or hostile and aggressive behavior. Disorganized type Grossly inappropriate or flat affect, incoherence, loose associations, and extremely disorganized behavior. Catatonic type Marked psychomotor disturbance (motionless or excessive motor activity), extreme negativism, mutism, pecularities of voluntary movement, echolalia, and echopraxia. Undifferentiated type Mixed schizophrenic symptoms (of other types) along with disturbances of thought, affect, and behavior. Residual type At least one previous, though not a current episode; social withdrawal; flat affect; and looseness of associations. Related disorder Schizophreniform-The client exhibits the symptoms of schizophrenia but less than 6 months. Social or occupational functioning may or may not be impaired.

Schizoaffective-The client exhibits the symptoms of pychosis and all the features of a mood disorder, either depression or mania. Delutional-The client has one or more nonbizarre delusions-the focus of delusion is believable. Psychosocial functioning is not markedly impaired, and behavior is not obviously odd or bizarre. Brief psychotic-The client experiences the sudden onset of at least one psychotic symptom, such as delusions, hallucinations, or disorganized speech or behavior, which last from 1day to 1 month. The episode may or may not have an identifiable stressor or may follow childbirth Shared Psychotic-Two people share a similar delusion. The person with this diagnosis develop this delusion in the context of a close relationship with someone who has psychotic delusions . Management Build trust Basic needs Reality Self-esteem Independence Medical Intervention

Treatment Psychopharmacology Psychosocial Treatment Antipsychotic medications / Neuroleptics: The conventional antipsychotic medications ex. Chlorpromazine dopamine antagonists target positive signs but have no observable effect on the negative signs. 2. The atypical antipsychotic medications ex. Clozapine both dopamine and serotonin antagonists target both positive and negative signs. Psychosocial treatment 1.Individual and group therapy - social contact and meaningful relationships with other people. 2. Social skills training - improve social competence. 3. Family therapy and education - make family members part of the treatment team. ----end--1.